:::.What is overactive bladder?
* ‘Overactive bladder’ (OAB) is increased urinary urgency, with or without urge urinary incontinence (UI), usually with frequency and nocturia. Urgency is the sudden, intense desire to urinate. Urge incontinence is defined as the unwanted urine leakage (referred to as “wetting accidents“) that happens shortly after urgency. Urge UI is caused by involuntary bladder contractions that occur as your bladder fills. With urge UI, a person may be aware of the urge sensation but will be unable to stop leakage before reaching the toilet. Urine loss is usually in large amounts that soak underwear and even outer clothing. Frequency is urinating more often than usual (more than eight times in a day).
An additional symptom seen very often, especially in the elderly, is nocturia, awakening more than one time at night to void. Getting up at night to urinate during the night will often disrupt sleep. Many people find it difficult to discuss their OAB problem with their doctor or nurse.
u Prevalence:
OAB is a bothersome medical condition that affects more than 17 million men and women of all ages, although its incidence increases significantly with age. In the past, many experts believed that such voiding dysfunction symptoms as urgency and frequency were harmless and did not cause significant problems for individuals.
New research shows that the triad of symptoms – urinary frequency, urgency and urge incontinence, alone or in combination – can have a significant impact on someone’s quality of life. Other medical conditions or diseases such as urinary tract infection or bladder tumors can cause bladder irritation leading to OAB. Some medical conditions, especially strokes, impair inhibition of bladder contractions (detrusor hyperreflexia).
Considered abnormal at any age, overactive bladder is a highly prevalent condition that affects both men and women but is more common in women. Many people never report symptoms of OAB due to their perceptions that treatment is not available or effective or that the symptoms are normal consequences of aging or childbirth. Effective treatment includes the combination of drug therapy with behavioral interventions.
u Impact:
OAB adversely affects a person’s daily routines and quality of life. Approximately two-thirds of men and women report that their symptoms have an effect on daily living such that they have a poor quality of sleep, more depression, and an overall lower quality of daily life than persons who do not experience OAB. In fact, compared with persons with diabetes mellitus, persons with OAB experience a lower quality of life. Weekly or more frequent urge incontinence with associated urgency and nocturia has been shown to increase the risk of falls in elderly women who are attempting to urinate during the night. OAB that includes urge incontinence is also a major contributor to the decision to admit an older person to a nursing home.
Overactive bladder has been called the closet disorder since only one-third of regularly incontinent women discuss their problem with a health care provider and two-thirds of patient’s first seeking medical advice have had their symptoms for more than two years. Instead of seeking help, many people with OAB adjust their habits and lifestyle to accommodate the management of symptoms and may adopt such coping mechanisms as restricting fluids and urinating to a timed schedule or at the first sensation of urgency. Car trips and vacations are limited. Shopping, visiting public places, entertaining or socializing are curtailed and in some cases stopped. Finding accessible public toilets, a behavior referred to as ‘toilet mapping‘, becomes a source of major anxiety. Initially, increasing the frequency of bladder emptying, often referred to a “defensive voiding” may reduce the number of incontinent episodes.
.::: Treatment of Overactive Bladder:
u Drugs
Agents that relax the detrusor or prevent a bladder contraction are effective for OAB and urge incontinence. Acetylcholine is a chemical released from nerves supplying the bladder that acts at muscarinic receptors to trigger a bladder muscle contraction, thereby producing urination. Antimuscarinics agents are used to treat OAB and urge incontinence. There are many antimuscarininc agents in the market and patient should consult her/his doctor before taking any of them.
u Behavioral Therapies
In addition to drug therapies for OAB and urinary incontinence, behavioral regimens have been shown to reduce symptoms of OAB. These regimens range from simple maneuvers such as timed or prompted urination (Bladder Retraining) and fluid management to biofeedback. Pelvic muscle exercises (Kegel exercises) are beneficial in appeasing urge incontinence, and can be done alone or in combination with antimuscarinic drugs. Also, patients may want to change certain aspects of their diets (e.g., decreasing caffeine or alcohol intake), lose weight and stop smoking.
u Neuromodulation
Additional options exist when drugs and behavioral therapies fail to improve symptoms in patients with OAB and urge incontinence. Electrical stimulation of nerves or regions of the skin, vagina or rectum innervated by the lower spinal cord can reduce OAB and urge incontinence.
u Surgery
Surgery to enlarge the bladder – called augmentation cystoplasty – can be considered when the bladder is extremely small or generates high pressure. This is major surgery with potential complications and should be attempted as a last resort. Other surgeries such as neurolysis to cut the nerves supplying the bladder are rarely performed. In some women with OAB and urinary incontinence who also exhibit vaginal prolapse (e.g., cystocele, enterocele) and stress urinary incontinence, correction of these conditions can improve the overactive bladder.
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